The Nuances of Therapy: A Psychodynamic Reflection on Working Online

There is a common assumption that something essential is lost when therapy moves online. That the subtleties, the unspoken moments, the psychodynamic nuances somehow disappear when therapist and client are no longer sharing a physical room. From my experience, I’m not convinced this is true (Can read about online vs in-person blog here). What has changed is not the presence of nuance, but where and how it appears.

In traditional psychodynamic work, the therapy room is intentionally designed as a neutral, containing space. It belongs to neither the therapist nor the client in a personal sense, and this neutrality allows unconscious material to emerge safely. Even the smallest details are considered. Take, for example, the box of tissues. In many psychodynamic modalities, we would not offer tissues to a crying client. The tissues are present and reachable, but the choice to use them belongs to the client. Offering them may unconsciously communicate a wish for the client to stop crying, to manage their feelings differently, or to soothe themselves before they are ready.

Online, that particular nuance disappears. There is no shared tissue box. And yet, rather than losing subtlety, different nuances emerge in its place.

When working online, the therapist is offered brief but meaningful glimpses into a client’s lived reality. An untidy bedroom, a cramped living space, a carefully curated background, or the absence of privacy can all carry meaning. Sometimes we gain insight into a client’s socioeconomic reality, or into the level of chaos or containment in their daily world. In person, the consulting room can protect the client from these exposures, a protection that many people find useful, and sometimes necessary. Online, however, the client’s world enters the frame. And instead of losing safety, we may gain perspective: a sense of the client’s everyday reality, and sometimes a level of comfort that can be harder to access within the more clinical atmosphere of a therapy room.

While the neutrality of the therapy room can be profoundly containing, there is also something clinically valuable about witnessing the environment a client inhabits. Their reality is no longer held at a distance; it is present, visible, and alive within the session.

Changes in setting take on new significance. In an in-person room, we might comment if something in the therapy space has changed, curious about how that change may affect the client. Online, noticing a client moving rooms, changing scenery, or choosing different locations becomes equally meaningful. Exploring how they feel in a particular space (or why one environment feels safer or more comfortable than another) can offer insight into how they experience safety, autonomy, and emotional containment in their wider life.

Other subtle details become available too. The way a client positions themselves on screen; close to the camera, further away, curled up on a bed, wrapped in a blanket, often happens without much conscious thought. These choices can reflect how much closeness, visibility, or protection feels tolerable at that moment. Rather than being distractions, they can gently inform conversations about vulnerability and relational distance, much as body language would in an in-person session.

In person, this might look like a client choosing the chair closest to the door, sitting further away, or gradually moving a chair closer over time. Online, it can show up differently: the distance from the screen, the choice to attend in a robe, the comfort of being wrapped in a blanket, or the way someone holds themselves when they feel exposed. These details don’t always “mean something deep”, but they can indicate subtle feelings, safety needs, and moments of vulnerability.

Self-soothing also appears differently online. Many clients have a cup of tea, water, or another comforting object with them during sessions. From a psychodynamic perspective, this can be understood as a way of regulating themselves while talking about difficult experiences. In a traditional consulting room, this might feel less accessible or less permissible. Online, it can allow clients to remain emotionally present while simultaneously caring for themselves, and the timing or need for comfort can itself become meaningful.

Interruptions, too, become part of the therapeutic material. Background noise from family members, housemates, pets, or daily life can intrude into the session. How a client responds to these disruptions; whether with irritation, anxiety, embarrassment, or dismissal, can mirror long-standing patterns around boundaries, frustration, and not having space for their own needs. Sometimes these moments are brushed aside quickly with “it’s fine” or “it doesn’t bother me,” but even that response can offer useful insight.

The way clients enter and leave sessions has also become more noticeable. In person, there is often a waiting room, a walk down a corridor, and a physical transition into and out of therapy. Online, that transition can be abrupt. A client may move from deep emotional work straight back into their day within seconds. Noticing how a client arrives; early, late, rushed, carefully prepared or how they end the session can reveal something about how they manage beginnings, endings, and emotional boundaries in their lives.

Certain details also change shape online. In person, a therapist might notice a client repeatedly looking at their phone. Online, that dynamic can be less obvious because the session itself happens on a device, but attention can still drift. You might notice someone looking away to read a message, check an email, or slip into “doing mode” when something emotionally important is happening. In some ways, this is simply the online version of the same phenomenon, and can be worth commenting on gently: what is pulling them away, what feels hard to stay with, and how they experience the importance of what is happening between us.

Even technical disruptions can carry meaning. A frozen screen or dropped connection can evoke frustration, anxiety, or feelings of abandonment. How easily someone tolerates these interruptions, or how repair feels after the connection is restored, can echo how they experience rupture and reconnection in relationships more broadly. In person, we may see something similar in different forms: frustration when time is up, anger about the ending, or the way a client enters the room after a difficult previous session. The setting changes, but the relational themes can remain recognisable and still meaningful.

Of course, not every nuance is explored in depth. Some pass quietly, unnamed. But they still matter. Each observation contributes to a fuller picture of the client’s internal and external world. Online therapy does not offer a diluted version of the work, it offers a different one: embedded in real life, shaped by context, and rich with information.

We have not lost the nuances of psychodynamic therapy by working online. We have gained others. The task remains the same: to notice, to wonder, and to think carefully about what emerges in the shared space, wherever that space happens to be.

If you are wondering whether online therapy can still feel meaningful, contained, or emotionally “real,” you are not alone in that question. Many people worry that something important might be missing without a shared room or physical presence. In practice, the work remains rooted in attention, curiosity, and relationship. What matters most is not the setting itself, but the care taken to notice what emerges within it. For some, online therapy offers a different kind of safety, one that allows them to bring more of their real, everyday world into the space, and to be met thoughtfully within it.

If you are considering online therapy and wondering whether it can feel safe, meaningful, or containing enough, you’re welcome to get in touch or read more about how I work.